Glyburide: Can Be High Risk in the Elderly

Beers CriteriaBeers Criteria Helps Keep Seniors Safe

The Beers Criteria* for potentially inappropriate medication use in older adults includes glyburide, due to prolonged hypoglycemic (low blood sugar) side effects which are seen in older patients.1 Studies have confirmed this risk when weighed against the other two second-generation sulfonylureas, glipizide and glimepiride. Both medications are still effective for patients with type 2 diabetes.

Glyburide fits the Beers Criteria because it continues to lower blood sugars by continually stimulating insulin secretion, even when the patient is experiencing a low blood sugar due to accumulation within the beta cells. This is not seen with other sulfonylureas medications. When, compared to glipizide, glyburide metabolizes to active metabolites that further accumulate in patients with renal dysfunction and has been associated with a two-fold increase of hypoglycemia in older patients. However, when patients switch to glipizide, significant reductions in hypoglycemic events resulted. Keep in mind that patients who converted to glipizide should be also monitored closely to adjust therapy as appropriate to maintain tight glycemic control.2

Sulfonylurea Conversion Table3

Drug
Usual Starting Dose

Comparative Daily Dose

 
Glyburide
2.5-5mg QD 1.25mg QD 2.5-5mg QD or
divided BID
5mg QD or
divided BID
10mg QD or
divided BID
20mg QD or
divided BID
Glimepiride
1-2mg QD 1mg QD 1-2mg QD 2mg QD 4mg QD 8mg QD
Glipizide
5mg QD or
divided BID
2.5mg QD 5mg QD or
divided BID
5mg QD or
divided BID
10mg QD or
divided BID
20-40mg divided BID

 

A comprehensive list of high-risk medications with additional information and suggested alternatives is available on our website. You may also review the complete NCQA list on the NCQA website.

*Wikipedia: The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, is a guideline for healthcare professionals' to help improve the safety of prescribing medications for older adults. It emphasizes de-prescribing medication which is unnecessary health care.

References:
  1. The American Geriatrics Society.AGS Beers Criteria 2012. AGS, 2012. Web. 3 Oct 2012.
  2. Skoff, RA, NV Waterbury, RF Shaw, JA Egge, M Cantrell. “Glycemic Control and Hypoglycemia in Veterans Health Administration Patients Converted from Glyburide to Glipizide.” Journal of Managed Care Pharmacy. 17.9 (2011): 664-671. Print.
  3. Sulfonylurea dose comparison. Pharmacist’s Letter/Prescriber’s Letter 2009; 25(8): 250801
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